Atypical eating disorder

This diagnosis is applied to a poorly defined group of patients.

It consists both of patients who simply fail to meet the diagnostic criteria of anorexia or bulimia nervosa, i.e. a normal weight anorexic (due to beginning anorexic behaviour from a heavier weight), as well as patients with distinct conditions. The latter group consists of patients who vomit when they are anxious or patients who are unable to swallow in public.

It is thought that this diagnosis may be applied to as many as 5% of the population.

(1).

In binge eating disorder the person engages in uncontrollable episodes of binge eating, but s/he does not use compensatory purging behaviours (1).

Onset is usually in the teenage years or in the early 20s. The sex ratio is more even than other eating disorders. Many individuals with binge eating disorder are obese. Depressive features are common. Binge eating episodes are associated with 3 or more of the following (1):

• eating noticeably rapidly than normal
• eating until feeling uncomfortably full
• eating large quantities of food when not physically hungry
• eating alone due to embarrassment of overeating
• feelings of disgust, depression or guilt after a binge

Most patients with BED can be successfully managed in primary care. Give patients, other family members and carers ongoing information and support, including self-help information. Evidence-based self-help programmes and/or medication with an antidepressant such as fluoxetine 60 mg daily are the treatment options (2).

If treatment is unsuccessful in primary care, consider direct referral for cognitive behaviour therapy if it is available, or for secondary care support via an eating disorders clinic, or the specialist psychiatric services, if the patient meets local referral criteria (2).

Reference:

• (1) NICE (2004). Eating disorders.
• (2) Simon C. Eating disorders. InnovAit 2008;1(11):759-763